Progesterone-Alone for Hot Flashes and Night Sweats?

Many women going through perimenopause and in menopause either don’t have have flashes and night sweats that bother them or are able to ease them with self-help approaches. However, between 7 and 9 percent of women have symptoms severe enough to interfere with their quality of life.

Because of these risks, new treatment options for vasomotor symptoms are needed. A new study published in the journal Menopause by the Centre for Menstrual Cycle and Ovulation Research looks at the safety and effectiveness of progesterone-only therapy for alleviating hot flashes and night sweats. (Progesterone is a hormone produced in the body, while progestin, which was used in the WHI, is a synthetic form of progesterone).

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In this trial, the researchers randomized 133 healthy, postmenopausal women with vasomotor symptoms to Prometrium, a brand of oral micronized progesterone, or placebo, and had them report on the frequency and severity of their night sweats and hot flashes over three months.

The researchers (one of whom, Jerilynn Prior, co-wrote the menopause chapter in the 2011 edition of Our Bodies, Ourselves) found that symptoms improved in both the progesterone and placebo groups over the course of the study. Scores, however, improved significantly more in the progesterone group, suggesting that the hormone provided greater relief of symptoms than placebo. There were few adverse effects reported in this brief trial, none of which were considered serious.

It is not clear what the breast cancer implications of progesterone-alone therapy might be – the Women’s Health Initiative trials found an increased risk of breast cancer with estrogen-plus-progestin therapy but not with estrogen-alone. In their article, the authors briefly address this issue, noting varying findings in other studies and remarking that:

Although there is reason to believe that progesterone has a more favorable safety profile than medroxyprogesterone [used in the WHI study], large safety trials of progesterone as postmenopausal monotherapy are lacking.

OBOS contacted researcher Jerilynn Prior to ask her if she had any additional comments about the potential increased risk of breast cancer. Prior answered that a large observational study in France called E3N found that estrogen with progesterone was not associated with increased breast cancer risk, while estrogen alone and estrogen with progestin were. “This suggests that progesterone alone would be safe in terms of breast cancer risk,” Prior noted.

In the published study, the researchers address certain limitations of their work, including the racial/ethnic makeup of their study population (primarily white), and participants being overall leaner and healthier than the general population. Additionally, while the placebo was identical to the active drug and neither the researchers or women could guess by the look or feel of the pill which they were taking, over time 54% of those receiving progesterone and 60% of those getting placebo were able to correctly guess their group assignment. In correspondence with OBOS, Prior said that this was likely due to the fact that many of those taking progesterone experienced improvement in their sleep.

The researchers also note that their population were postmenopausal, having not menstruated for 1-10 years, so their findings are not applicable to women transitioning into menopause.

The bottom line is that progesterone-alone may be a useful treatment for relieving hot flash and night sweat symptoms of menopause, although more investigation is needed. Many of the benefit and harms of hormone therapy may turn out to depend on the type of hormone, who’s using it, in what form, when and for how long. I hope to see more studies on this in coming years.

I am in the last phase of the MSFlash study to compare estrogen, venlafaxine and placebo for hot flashes. I was convinced I was on placebo because my hot flashes continued unabated especially at night, disturbing my sleep. Well wouldn’t you know? I was on estrogen….. no effect. But the researchers have placed me on progesterone for two weeks to phase off of estrogen and hey! I’ve had a reduction in both intensity and quantity of hot flushes. I realize that I probably still have some estrogen in my body but I’m excited with the response to progesterone!

THANK GOD!!! Finally! After years, someone who is like me, Peg! Out of 8 doctors, I was told 8 different opinions from M.D.’s to interests to ob/gyn’s. I was told “Don’t take one without the other”. When I take progesterone w/o estriodial, I am calmer and sleep better. If I take estriodial I am completely irritable. Apparently we have enough estrogen, just not enough progesterone. The doctors aren’t taking that into consideration! They won’t even do blood work to confirm. I have to go to my internist to do that. How is this even legal to dispense hormones or Pharms w/o checking levels!???? (I live in the U.S. btw) go figure *ugh
I’m glad I’m not alone and not mental and someone has actually confirmed all my research… (North American Menopausal Society, Web M.D. and multiple other sites )
Blessings and hugs!

thanks for your feedback I got off both the estrogen patch and my prometrium and after 4 months got hot flashes again. I really didnt want to go back on estrogen but I will jus take my 100 daily prometrium alone at night, that works for me. Now I hope I dont gain weight… thanks

I totally agree with you! I had been prescribed estradiol plus Prometrium and had an awful week of irritability and sleepless nights + nightmares. Stopped the estradiol, continued the progesterone alone, and felt great.

I’m 65, have been on estrogen/progesterone for 20 years with absolutely NO problems; then my new gyno said I should tapper off then get off them. I did. Within a few weeks I had trouble falling and staying asleep. After researching, found that progesterone by itself, is ok and I’ve been sleeping well since. Is it safe or risky to keep taking progesterone alone?

I agree with you Rachel: Many women going through perimenopause and in menopause either don’t have have flashes and night sweats that bother them or are able to ease them with self-help approaches. I also read an article that one study found that about 1 in 5 women aged 40 to 55 who still had regular periods experienced night sweats. I’ll share you that link so you can read the full article http://bioidentical-testosterone.com/night-sweats-in-women/

I was thrown headlong into menopause at 43 because of tumors on my ovaries and massive endometriosis, which resulted in an utterly complete hysterectomy. I cannot take Estrogen at all because it could encourage growth of endo if any seeds of it remain. I was prescribed progesterone only and it does take the edge off the worst of the hot flashes and night sweats. I know this because I’ve forgotten to take it on schedule and suffered the consequences.

I have been using bioidentical progesterone ONLY on and off for several years for PMS, hypothyroidism and premenopausal symptoms (what a combination). I just started back a couple of months ago to help with hot flashes and breast tenderness, a dab on each wrist. And for headaches, I dab it behind both ears. It’s works great! I even sleep better. But I have to use before bed time as it make me sleepy during the day. Will continue using it, hopefully I can start using it in the morning as well. since it state yiu can use it twice a day.

I took bioidentical progesterone for 9 months and started losing most of my hair and my mind. I found out mydroxyprogesterone is pregnant mare urine and can cause dementia after a certain amount of time. I went back to normal progesterone which was denied for insurance reasons and now I am much better. Please be careful. I care about all of us. It’s a very scary and confusing time of life.

Mydroxyprogesterone is not bioidentical progesterone. It also made me very sick when I took it with Premarin. Prometrium is bioidentical and did not cause any adverse effects when I switched to it with Estradiol. I am now trying prometrium alone and it is amazing!

After the birth of my first child I was placed onto progesterone birth control Depo Provera for 30 years. It is administered every three months and stops your period. It is given to the rural African community. I can report never having any problems on this treatment. Previously I had taken birth control pills which led to breast pain, weight gain , irritability and other side effects. None of these with progesterone. Ones period starts up again after one year of stopping the injection as I was told. I stopped taking the injection at age 45 to see if I was menopausal. My period never returned but a lot of symptoms of menopause occurred. Flashes. Sweats, anxiety, joint pain, memory fog and the rest. I have been back to my doctor and requested that he continue giving the injection. It relieves all the above with no breast tenderness. I believe that more research should be done regarding progesterone treatment alone for menopausal woman.

My doctor gave me Estradiol, and 2.5mg of Provera. I also take meds for anxieties, sleep and moods.
Will the 2.5 mg of Provera calm my hot flashes, my anxieties, with the help of my psych meds. Do i really need to take the Estradiol if the progesterone works good a lone I will try that please write back and let me know

I had a full hysterectomy about 4 years ago and have been on an estrogen patch for severe hot flashes and mood swings.
I have of late also not been able to sleep. My PCP prescribed me progesterone pills to see if it would help. I dare say while I seem to be sleeping more deeply, I have been woken up with a new onset of hot flashes.
Can this be due to the medication change?